High and Low Heart Rate Settings?

Hmmm... I'm reading a lot of interesting things about exercising and PM's, ICD's. I just had my ICD installed 4 days ago after I passed out while jogging (EKG's showed very long QT intervals). I enjoy running about 3 - 4 miles every other day and I ALSO like to do fartlek and speed training to get the most out of my workouts and constantly improve my 5K times.

My resting heart rate is around 50 - 55 (this drops down to mid 40's when I'm asleep) and I comfortably run at about 180, so it's quite a swing in heart rate. When I'm sprinting or doing speed training I can push up to mid 190's and have seen myself hit 200. None of these stats seem to worry my EP's they've done tests on my heart and say it's in great shape (it's just these weird EKG's that lead them to believe I'm at high risk for SCD.... oh, and the syncope episode of course).

Well I agreed to this ICD so that I could continue my lifestyle w/out fear and not be hampered. So they set my ICD at 40 for a low (will not pace me unless i drop below 40) and at 220 for a high (not that I ever get up that high but they believe when I go into this tachacardyia it's at an alarming rate and they don't want me to trigger anything just by exercising).

For all you exercise buffs out there, how are your settings and does this sound reasonable to you? From what i understand this ICD can detect arrythmias and correct them so even if something like that happened at 180 BPM the ICD would kick in (but it wouldn't shock me unless I got to a rate that my heart couldn't handle... but i'm handling 190's on a regular basis).

Just thought i'd throw this out there for discussion... thanks!

3 Comments

So interesting...

by bambi - 2008-06-09 09:06:09

how differently we are all set at! I've always been very active, and never had any problem getting my heart rate up to 180-190. My problem was inappropriate tachycardia and atrial fib. I could get it up there alright, but it didn't want to come down! After 3 ablations, I went "brady" and started passing out. So, my entire sinus node was ablated and the pacemaker put in. I'm pacing 98 to 100% in the atrium and about 15% in the ventricles. My rate response is always on because I can't get my heart rate up to what I need it to be when I start exercising. After years of adjusting, my lower rate started at 80, and they've been able to get it down to 70. If it's lower, I feel awful and start passing out. Weird huh? Also, the St. Jude tech said that my upper rate is set at 140, but if I go above that, the pacemaker will let it! It also won't record any higher rate than 140. So when I tell my Dr. I felt like I was having episodes of afib last summer, he looked at my print out and said there were no episodes recorded. Once again making me feel like I was dreaming it all up! But the tech who interrogated my pacer, cleared it up by saying that if my rate went over 140, it would not record it. Many times you can get the techs to share more info with you than the Dr. Many Dr.s issue a "gag" order though, and don't want the technicians giving us too much information [about our own health of course!] It may take you some time to find the right settings that fit your needs. Just be persistent, and usually they get it right eventually!
Welcome to the club!
Bambi

similar to mine..

by turboz24 - 2008-06-09 11:06:09

My lower is set at 40 bpm for pacing. It's really only there for when your ICD fires, sometimes your heart doesn't come back to to "speed" quicklly, so the pacer function is there for that case.

My monitor point is 180, but the ICD does nothing until I exceed 220 bpm, then it attempts to control the tachycardia, if I go over 240, then it goes into full defib mode.

I think this is pretty common for anyone with a heart in good condition that only has a tachycardia issue.

Thanks for replies guys

by ghettofibrullous - 2008-06-11 08:06:14

Wanted to say thanks everyone for your responses. Sounds like my settings are pretty typical then.

I didn't realize there was a sleep mode or a rate response mode (so I don't think i have either of these features turned on), cathrynb that's really cool, you're teaching me something new!

I think the 220 upper limit is to catch any tachycardia as that's what they THOUGHT happened to me (I passed out while jogging and faceplanted), but they were not able to find anything in the electrophysiology study -- but they did say my EKG's were very abnormal and they suspected long QT. I have gotten to 205 exercising before so I think they set it at 220 as my heart can handle 205 for a little bit and they don't want it needlessly shocking me (thanks docs). =-)

I've never been symptomatic from a low heart rate and I don't think it usually drops much under 45 when I'm in a dead sleep. At wake the lowest I get is around 50. I it can zap me back to normal before (hopefully) I pass out and get any sort of damage. The low setting I guess would just be there as a safety net if the heart needed to get back up to speed or something (what Turboz said makes sense). But do you or anyone know if the heart can go into a strange arrhythmia at an average rate like 150 or something? Or is the reason it's dangerous is when it's faster than your heart is used to and the oxygen can't get there? Must be or else I guess they would be worried about a strange rhythm in the mid ranges, huh? (sorry if i sound stupid, i'm new to this heart stuff).

Ugh, i hadn't thought about it before but if someone (like me) has a heart arrhythmia at 29 years of age does that mean I'm in for more heart problems down the road and I just have a dud heart? It sounds like Bambi's just seemed to flip flop from VT to brady? (was it the ablations that caused this?)



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